Tech notes: VTE smart groups get smarter

April 2013

To prompt improvements in venous thromboembolism (VTE) prophylaxis rates, Legacy Health is updating the VTE prophylaxis sections in Epic order sets, also known as smart groups.

Continued focus on Surgical Care Improvement Project (SCIP) outcomes and new Centers for Medicaid and Medicare Services (CMS) value-based purchasing incentives make VTE prevention a key initiative for Legacy.

Smarter smart groups

The most frequently used order sets for Medicine, Surgery (encompassing general, GI, hepatic, gynecologic, urologic, vascular, OBC, plastic and reconstructive surgery), Neurosurgery and Trauma are being updated to include these smarter smart groups in this first round of changes.

Changes to remaining, less-frequently used order sets are planned for the May and June Epic enhancement releases.

Orthopedic, Bariatric, Obstetric and Pediatric order sets are NOT being updated.

What’s changing

What’s changing with the VTE prophylaxis smart groups?

The smart groups will now display the VTE risk level (low, moderate or high), based on the VTE risk score. The smart groups will also display a set of service-specific (Medicine vs. Surgery vs. Neurosurgery vs. Trauma) recommendations for pharmacologic and/or mechanical prophylaxis appropriate for that risk. All recommendations made will comply with SCIP and CMS value-based purchasing approved measures for prophylaxis.

If no VTE score has been documented, providers will be prompted to complete the VTE risk assessment themselves via the admission or rounding navigators, or to order low-molecular-weight heparin (LMWH) per pharmacy protocol with the expectation that the pharmacy will order pharmacologic therapy once the risk assessment has been completed.

The updated smart groups will notify providers if no action is necessary because mechanical and/or pharmacologic prophylaxis have already been ordered.

The reasons available for documenting that prophylaxis is either not indicated or contraindicated have been updated and are more comprehensive. The mechanical and pharmacologic not-indicated/contraindicated orders will also be available as standalone orders on med lists. This is so that they may be placed easily outside of order sets.

Other changes

Other changes have also been implemented system-wide to support VTE prevention measures.

Nursing has been assigned the task of performing the VTE risk assessment at admission, pre-admission, pre- and post-operatively, and with any changes in the patient’s clinical condition or level of care.

Patient education materials about the importance of VTE prevention have been updated and are posted on the Legacy intranet.

If you have any questions about the smarter VTE prophylaxis smart groups or new VTE prevention measures, please contact Tanya Shanks-Connors.